System and method for the inference of activities of daily living and instrumental activities of daily living automatically

ABSTRACT

A method and related system to, among other things, automatically infer answers to all of the ADL questions and the first four questions of the IADL in the home. The inference methods detect the relevant activities unobtrusively, continuously, accurately, objectively, quantifiably and without relying on the patient&#39;s own memory (which may be fading due to aging or an existing health condition, such as Traumatic Brain Injury (TBI)) or on a caregiver&#39;s subjective report. The methods rely on the judicious placement of a number of sensors in the subject&#39;s place of residence, including motion detection sensors in every room, the decomposition of each relevant activity into the sub-tasks involved, identification of additional sensors required to detect the relevant sub-tasks and spatial-temporal conditions between the signals of sensors to formulate the rules that will detect the occurrence of the specific activities of interest. The sensory data logged on a computing device (computer, data logger etc.), date and time stamped, is analyzed using specialist data analysis software tools that check for the applicable task/activity detection rules. The methods are particularly useful for the continued in-home assessment of subjects living alone to evaluate their progress in response to medical intervention drug or physical therapy or decline in abilities that may be the indicator of the onset of disease over time. Measuring the frequency of each activity, the time required to accomplish an activity or a subtask and the number of activities/subtasks performed continuously over time can add extremely valuable quantification extensions to the existing ADL and IADL evaluation instruments, as it will not only reveal important information setting up a baseline for activity levels for each activity, but will also easily allow the detection of any drift from these personalized norms.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims priority from U.S. Provisional Application No.60/551,894, filed on Mar. 10, 2004, entitled “Apparatus and Method forthe Inference of Activities of Daily Living and Instrumental Activitiesof Daily Living Automatically,” the disclosure of which is herebyincorporated by reference in its entirety.

BACKGROUND OF THE INVENTION

Functional assessment of a person's health status, or recuperation afterinjury, hospitalization and treatment is of primary concern in medicine.Most branches of Medicine, including geriatrics, rehabilitation andphysical therapy, neurology and orthopedics, nursing and elder careresearch studies currently rely on one of three basic strategies:self-report (either in questionnaires, or structured interviews),observational judgment by professionals or family members (such as theActivities of Daily Living [ADL] scales (Katz 1963), and theInstrumental Activities of Daily Living [IADL] scales (Fillenbaum1985)), or demonstrated performance of specific skills. Despite beingconsiderably useful, one challenge of these approaches is to relate thefindings obtained in the physician's office or research laboratory withthe person's function at home (Reuben 1995). An implicit assumption isthat an individual's functional ability is independent of theenvironment. Clinical experience suggests that an individual'sfunctional ability is actually environment-specific, since functionincreases when subjects are in familiar surroundings due to reducedconfusion (Kane 1985). The artificial setting of direct observation in adoctor's office or laboratory setting does not allow the observer todetermine the effect of environmental barriers such as unfamiliarity orartificiality on function. Moreover, one-time assessment of functiondoes not allow for assessment of variability of functional performanceover the course of a day or several days. Further, one-time measurementof function does not allow for assessment of change, and episodic,rather than continuous measurement of function does not permitdetermination of the rate of change, a parameter which is vitallyimportant in determining the adequacy of certain clinical services andtreatments (such as rehabilitation) following functional loss. Theaccuracy of a prognosis is improved by measuring the rate of change of apatient's condition.

Since there is little correlation between the presence of a certaindisease and its impact on an elder's functional abilities, directassessment of function is an integral part of geriatric care. Forexample, an octogenarian with systolic hypertension, congestive heartfailure, maturity-onset diabetes mellitus, severe osteoarthritis and apast history of hip fracture might be a vigorous, independent communityvolunteer, or a frail, highly dependent resident of a nursing home(Fried et al. 1997).

Despite a variety of activities of daily living (ADL) tools developedover the last several decades, a consensus exists with regard to thebasic components of such functional assessments. Almost all validatedscales include measures of dressing, bathing, toileting, transfer andfeeding ability (Fleming et al. 1995). ADL scores indicate the degree towhich an individual has independent functioning in each of the self-careareas. However, progress in the assessment of function since the early1960's has not been well implemented in everyday assessment strategies.

Many devices have been invented to continuously measure the activitylevels of patients and to assess their functionality, usingpiezoelectric sensors and accelerometers (such as that of Dynaport).However, these devices measure activity level and do not really discern,measure or assess the activities of daily living or instrumentalactivities of daily living (IADL) score comprises six questions thatcorrespond to the individual's ability to bathe, dress, use the toilet,move in out of bed, control their bladder or bowels and feed themselveswithout help. Similarly, IADL score includes five questions that seekinformation about the individual's ability to get to places that areoutside walking distance, go shopping for groceries, prepare meals, dohouse work and handle finances without help. None of these devices canautomatically infer any the above-mentioned activities specifically.

BRIEF SUMMARY OF INVENTION

The various embodiments of the present invention provide a method andrelated system that, among other things, automatically infer answers toall of the ADL questions and the first four questions of the IADL in thehome. The inference methods detect the relevant activitiesunobtrusively, continuously, accurately, objectively, quantifiably andwithout relying on the patient's own memory (which may be fading due toaging or an existing health condition, such as Traumatic Brain Injury(TBI)) or on a caregiver's subjective report. The methods rely on thejudicious placement of a number of sensors in the subject's place ofresidence, including motion detection sensors in every room, thedecomposition of each relevant activity into the sub-tasks involved,identification of additional sensors required to detect the relevantsub-tasks and spatial-temporal conditions between the signals of sensorsto formulate the rules that will detect the occurrence of the specificactivities of interest. The sensory data logged on a computing device(computer, data logger etc.), date and time stamped, is analyzed usingspecialist data analysis software tools that check for the applicabletask/activity detection rules. The methods are particularly useful forthe continued in-home assessment of subjects living alone to evaluatetheir progress in response to medical intervention drug or physicaltherapy or decline in abilities that may be the indicator of the onsetof disease over time. Measuring the frequency of each activity, the timerequired to accomplish an activity or a subtask and the number ofactivities/subtasks performed continuously over time can add extremelyvaluable quantification extensions to the existing ADL and IADLevaluation instruments, as it will not only reveal important informationsetting up a baseline for activity levels for each activity, but willalso easily allow the detection of any drift from these personalizednorms.

An aspect of an embodiment of the present invention provides a method toautomatically derive answers to the questions of two clinical functionalassessment instruments activities of daily living (ADLs), and all butone of the instrumental activities of daily living (IADLs) relying onsensors targeting the side-effects of the activities. This method maycomprise: 1) date and time stamping sensor firings; and 2) setting a setof rules method where the spatio-temporal relationships of sensorfirings are examined and analyzed to infer the occurrence of activitiesof interest. Theses rules may include at least one of the following: arule to automatically bathing/showering; a rule to automatically detectdressing; a rule to automatically detect toileting events; a rule toautomatically detect the ability to ambulate (get out of bed/chair); arule to automatically detect problems in controlling bladder and/orbowels; a rule to automatically detect the ability to feed oneself; arule to automatically detect the ability to get to places outside ofwalking distance; a rule to automatically detect the ability to shop forgroceries; a rule to automatically detect the ability to prepare meals;and a rule to automatically detect the ability to do house work.

An aspect of an embodiment of the present invention provides a system toautomatically derive answers to the questions of two clinical functionalassessment instruments activities of daily living (ADLs), and all butone of the instrumental activities of daily living (IADLs). This systemmay comprise: 1) a sensor module, wherein the sensor module targets theside-effects of the activities; and 2) a processor module, the processormodule programmed to a) date and time stamp sensor firings; and b) set aset of rules where the spatio-temporal relationships of sensor firingsare examined and analyzed to infer the occurrence of activities ofinterest. These rules may include at least one of the following: a ruleto automatically bathing/showering; a rule to automatically detectdressing; a rule to automatically detect toileting events; a rule toautomatically detect the ability to ambulate (get out of bed/chair); arule to automatically detect problems in controlling bladder and/orbowels; a rule to automatically detect the ability to feed oneself; arule to automatically detect the ability to get to places outside ofwalking distance; a rule to automatically detect the ability to shop forgroceries; a rule to automatically detect the ability to prepare meals;and a rule to automatically detect the ability to do house work.

An aspect of an embodiment of the present invention provides a computerprogram product comprising computer useable medium having computerprogram logic for enabling at least one processor in a computer systemto automatically derive answers to the questions of two clinicalfunctional assessment instruments activities of daily living (ADLs), andall but one of the instrumental activities of daily living (IADLs)relying on sensors targeting the side-effects of the activities. Thiscomputer logic may comprise: 1) date and time stamping sensor firings;and 2) setting a set of rules method where the spatio-temporalrelationships of sensor firings are examined and analyzed to infer theoccurrence of activities of interest. These rules may include at leastone of the following: a rule to automatically bathing/showering; a ruleto automatically detect dressing; a rule to automatically detecttoileting events; a rule to automatically detect the ability to ambulate(get out of bed/chair); a rule to automatically detect problems incontrolling bladder and/or bowels; a rule to automatically detect theability to feed oneself; a rule to automatically detect the ability toget to places outside of walking distance; a rule to automaticallydetect the ability to shop for groceries; a rule to automatically detectthe ability to prepare meals; and a rule to automatically detect theability to do house work.

These and other objects, along with advantages and features of theinvention disclosed herein, will be made more apparent from thedescription, drawings and claims that follow.

BRIEF SUMMARY OF THE DRAWINGS

The accompanying drawings, which are incorporated into and form a partof the instant specification, illustrate several aspects and embodimentsof the present invention and, together with the description herein,serve to explain the principles of the invention.

The drawings are provided only for the purpose of illustrating selectembodiments of the invention and are not to be construed as limiting theinvention.

FIG. 1 provides a schematic block diagram of an embodiment of thesubject ADL system.

FIG. 2 provides a functional block diagram for an illustrative computersystem for implementation of an embodiment of the present invention.

DETAILED DESCRIPTION OF THE INVENTION

The various embodiments of the present invention provide a method andsystem to, but not limited thereto, automatically infer answers for allof the ADL questions and the first four questions of the IADL in thehome. In an embodiment the present invention method automatically infersanswers to all ADL question, and thus will be dubbed AADL for AutomaticADL. This method may use a motion detector in each room, humiditysensors, pressure mats, and electronic noses (odor detecting sensors).

Similarly, a second method of the present invention automatically infersanswers to four of the IADL question. The fifth question, regarding theindividual's ability to handle money and financial transactions withouthelp, could be answered. However, it should be appreciated that it is asensitive and a confidential matter that may cause problems ofguardianship and the like; hence, the answer to this question is bestasked directly, rather than inferred automatically, if it is relevantfor the purpose of the evaluation. We will dub this method AIADL forAutomatic IADL. This method may also use motion detectors in each room,humidity sensors, cabinet door switches, a kitchen food scanner (thesubject of a separate disclosure), radio frequency transmitter-receiver,infra red transmitter-receiver, refrigerator door switch, microwave doorswitch, temperature sensor, humidity sensors and sensors to detect theoperation of the washing machine, dishwasher, the vacuum cleaner and theiron. It should be appreciated that additional questions or fewerquestions may be implemented as well.

In both methods discussed above, data from the sensors may be logged ona computing device (computer, data logger or a universal data loggingand communications module), date and time stamped. The data is analyzedto check the spatial-temporal conditions of sensory data thatcharacterize the relevant subtasks and in turn the activities ofinterest, using special data analysis software tools. The methodsdisclosed herein are particularly useful for the continued assessment ofsubjects living alone in their home to evaluate their progress inresponse to medical intervention, drug, physical and/or rehabilitationtherapy or decline in abilities that may be the indicator of the onsetof disease. Nevertheless, the methods apply to situations where morethan one person is present in the home, if subjects were identified tothe analyzing computer system, such that different activities takingplace at the same time could be recognized and linked to a specificuser. This can be done via several techniques, including, but notlimited to, having the users carry Radio-frequency identification chips(RFID), electronic tags, or electronic communications device (such asBluetooth devices).

In both methods, the frequency of each activity, the time requiredaccomplishing an activity or a subtask and the number ofactivities/subtasks performed will be continuously recorded over time.The measurement information will form a norm of personalized activitylevel, against which the most current activity levels can be compared todetect any drift from this norm.

Referring to FIG. 1, FIG. 1 is a schematic block diagram of anembodiment of the subject ADL system 100. Sensors 102 targeting theincidental effects of the activities of interest areembedded/distributed in the living space or area (not shown) of thepatient 104. The sensors 102 communicate with a data/collection analysiscomputer/processor 106 via hard wire or wireless connection 108. Thecollected/analyzed data may be stored in storage/archive 110. The rulebased algorithms and methods 112 may be applied to and implemented withthe computer/processor 106 and storage/archive 110.

1—Method for the Inference of Automatic Activities of Daily Living(AADL):

Before describing an embodiment of the present invention method indetail, we will list the ADL questions that are conventionally asked ininterviews with patients during their visits to the physician. We willlater take each of these questions, decompose its main activity intosubtasks, identify the sensors needed to detect the subtasks/activity,determine the necessary and sufficient logical conditions governing thespatial-temporal relationship between sensors' signals that allow it toinfer the answer, and will finally describe how the answer can beinferred automatically.

Questions for evaluating the Activities of Daily Living are:

-   -   1. Do you bathe yourself without help?    -   2. Do you dress yourself without help?    -   3. Do you use the toilet without help?    -   4. Do you move in and out of bed without help?    -   5. Do you have any trouble controlling your bladder or your        bowels?    -   6. Do you feed yourself without help?    -   (Adapted from: Katz S, Ford A B, Moskowitz R W, Jackson B A,        Jaffe M W, Cleveland M A. The index of ADL: A standardized        measure of biological and psychosocial function. JAMA. 1963;        185:914-919.)

The automatic inference of answers to these questions relies on arequired set of sensors relevant to the activity and all its relatedsubtasks, a data logging system and a computer running a softwareprogram that implements the check on the conditions characterizing theactivity. In what follows we will outline an embodiment of the sensorsrequired for question/activity and sufficient conditions.

Do You Bathe Yourself Without Help?

To automatically infer the answer to this question, we need to establishthat the subject is either alone at home, or that he/she carried out thebathing activity alone and without help from others. The person can beconfirmed alone if the array of motion sensors (one in each room) fireonly in one room at a time with a clear spatial-temporal relationbetween sensor firings that is sensible with respect to the floor plan.However, motion detected only in one room, the bedroom for instance,followed by motion detected in the bathroom, without any motion detectedin the hallway connecting between the two rooms in the period betweenthe two sensors' firings is an indicator of more than one person in thehome. Similarly, simultaneous motion sensor firings in different roomsare also indicative of the presence of others in the home.

Unfortunately, low-cost motion detecting sensors will not be able todifferentiate the motion of one person from that of two persons movingtogether. Hence, it is necessary to establish, with a high degree oflikelihood, that the subject is alone when they have bathed, throughconfirmation that the front door motion sensor, and the geographicallysubsequent sensors, did not fire prior the bathing action. Thus we canestablish that no one came into the home to accompany the subject intothe bathroom to help him or her bathe.

Additionally, if other motion sensors' information indicates thepresence of another person in the home, in addition to the monitoredsubject, before bathing took place, then we must establish that thesubject bathed on their own. This can be established by continued sensoractivity outside the bathroom while the subject is bathing/showering.

Bathing activity can be established if the bathroom motion sensor firedand the output signal of a humidity sensor placed in the bathroomextremely increased, and the subject remained in the bathroom for aperiod of time indicative of a bath or a shower (normally 8 minutes ormore). To differentiate between bathing and acts associated withincreased humidity in the bathroom, like washing the hands and the facewith hot water or shaving, a presence sensor (pressure mat or infra redbeam break for example) must be placed in front of the sink; when aperson stands on the mat it will generate a binary one signal, however,when the subject is in the bathtub or the shower, the output of thepressure mat is zero.

Consequently, the detection of the activity of bathing requires, inaddition the motion detection in every room, a pressure mat in front ofthe bathroom sink and a humidity sensor in the bathroom.

The inference rule will be:

If {(Subject went into the bathroom) AND (Subject remained in thebathroom for 8 minutes or more) AND (Humidity excessively increasedduring the activity period) AND (Subject was NOT standing on thepressure mat placed in front of the bathroom sink during the activityperiod)} AND {[(Subject is alone at home) AND (There is NOT anyindication from the motion sensors of any visitors coming into theresidence through outdoor(s) prior to the activity)] OR [(Subject hascompany) AND (Motion Sensors show continued activity during the activityperiod outside the bathroom)]}, Then Subject has bathed without help.

The logical spatial temporal conditions embraced by the first set ofbrackets, characterize the concerned activity, bathing for thisparticular question, where as the set of conditions embraced by thesecond set of brackets establish that the subject is either alone or didnot receive help of another person during the activity. If the activityconditions were True, i.e. the activity has taken place, but the secondset of condition could not be confirmed, the inference system can reportbathing probably with the help of others. The percentage of help withthe activity can be estimated from the ratio between the periods of timewhen no motion detected outside the bathroom (or the room where theactivity takes place in general), to the time taken to perform theactivity. The estimated percentage of help, together with the frequencyof the activity, and the time required to carry-out the activity willallow attaching a value that quantifies the response, rather than havinga yes or no answer to the questions. The help estimate, the frequencyand time required to do accomplish the activity are generic and can beapplied to quantify the answer for all of the traditional ADL/IADLquestions.

Do You Dress Yourself Without Help?

The answer to this question can be formulated in the following rule:

If {(Subject went out of their residence)} AND {[(Subject is alone athome) AND (There is NOT any indication from the motion sensors of anyvisitors coming into the residence through outdoor(s) prior to theactivity)] OR [(Subject has company) AND (Motion Sensors show continuedactivity during the activity period outside the bedroom)]}, Then Subjecthas been able to dress without help.

This is true, because normally people get dressed before leaving theirhomes, and they usually get dressed in the bedroom. We can establishthat the subject went out of their residence through tracking thesubject's movement, from the signal of the motion detectors, towards theexit door and then disappearing form the sensors for some time.

Do You Use the Toilet Without Help?

This question can be answered using the following rule:

If {(Subject went into the bathroom) AND (Subject remained in thebathroom for some time) AND (Subject was NOT standing on the pressuremat placed in front of the bathroom sink during the activity period) AND(Humidity did NOT excessively increased during the activity period) AND(an electronic nose detected characteristic odors) AND (Toilet wasflushed)} AND {[(Subject is alone at home) AND (There is NOT anyindication from the motion sensors of any visitors coming into theresidence through outdoor(s) prior to the activity)] OR [(Subject hascompany) AND (Motion Sensors show continued activity during the activityperiod outside the bathroom)]}, Then Subject has used the toilet withouthelp.

The use of an electronic nose to detect odors characteristic of usingthe bathroom is not absolutely necessary, however it providesconfirmation. Hence, it is best to install an electronic nose in thebathroom tuned to detect such odors. Toilet flushing can be detected viaa tilt switch attached to the float in the tank or to the flushinghandle.

Do You Move in and Out of Bed or Chair Without Help?

The answer to this question can be automatically inferred by the twofollowing rules:

If {(Subject is lying in bed) AND (Subject Stood up)} AND {[(Subject isalone at home) AND (There is NOT any indication from the motion sensorsof any visitors coming into the residence through outdoor(s) prior tothe activity)] OR [(Subject has company) AND (Motion Sensors showcontinued activity during the activity period outside the bedroom)]},Then Subject has moved out of bed without help.

A sensor (pressure mat, load cell, pressure baldder or similar) placedunder the bed's mattress to detect lying in bed, and another sensor onthe floor at the exit point of the bed to detect standing up arerequired. Similarly, the activity of moving in and out of a chair can bedetected by using the same rule and placing sensors under chair cushionsand in front of commonly used chairs.

If {(Subject is sitting in chair) AND (Subject Stood up)} AND {[(Subjectis alone at home) AND (There is NOT any indication from the motionsensors of any visitors coming into the residence through outdoor(s)prior to the activity)] OR [(Subject has company) AND (Motion Sensorsshow continued activity during the activity period outside the room)]},Then Subject has moved out of the chair without help.

Do You Have any Trouble Controlling Your Bladder or Bowels?

The answer to this question can be automatically inferred by installingan electronic nose that can detect characteristic odors in the followingplaces: the bedroom, the laundry room and/or near the usual place wherethe subject keeps dirty laundry before it is washed (e.g. laundrybasket).

Do You Feed Yourself Without Help?

Usually, feeding involves preparing a meal before eating, and cleaningup after. Hence, one way to answer this question unobtrusively is thefollowing rule:

If {(Subject is in the kitchen) AND (There are activities in thekitchen) AND [there is an increase in the temperature over the stove,range, or oven) OR (Use of microwave oven)] AND [(Dishwasher door open)OR (Increase of humidity over the kitchen sink)]} AND {[(Subject isalone at home) AND (There is NOT any indication from the motion sensorsof any visitors coming into the residence through outdoor(s) prior tothe activity)] OR [(Subject has company) AND (Motion Sensors showcontinued activity during the activity period outside the kitchen)]},Then Subject has prepared a meal, cleaned up and fed themselves withouthelp.

Activities that are indicative of preparing a meal in the kitcheninclude any change of status detected from the kitchen cabinets anddrawers' switches, refrigerator door switch, microwave door switch andthe like.

An electronic nose, tuned to detect cooking odors, can placed in thekitchen to give added confirmation of the activity of cooking, but isnot absolutely necessary. The humidity sensor, positioned over thekitchen sink will detect washing up the dishes after the meal.

However, a person may prepare the meal, eat and postpone the cleaningtill later. In this case, the following rule maybe sufficient:

If {(Subject is in the kitchen) AND (There are activities in thekitchen) AND [(There is an increase in the temperature over the stove,range, or oven) OR (Use of microwave oven)]}AND {[(Subject is alone athome) AND (There is NOT any indication from the motion sensors of anyvisitors coming into the residence through outdoor(s) prior to theactivity)] OR [(Subject has company) AND (Motion Sensors show continuedactivity during the activity period outside the kitchen)]}, Then Subjecthas prepared a meal and fed themselves without help.

The first rule is indicative more of completing all the subtasksinvolved in the direct feeding process and hence would score morepoints; this also reflects getting a higher score for being more activeby doing an additional task, in this case washing dishes after the meal.

2—Method for the Inference of Automatic Instrumental Activities of DailyLiving (AIADL):

The questions that are asked of patients to infer InstrumentalActivities of Daily Living are:

-   -   1—Can you get to places outside of walking distance without help        (for example travel alone on buses, taxis, or drive a car)?    -   2—Can you go shopping for groceries without help? (Assumes the        patient has transportation).    -   3—Can you prepare your own meals without help?    -   4—Can you do your housework without help?    -   5—Can you handle your own money without help (for example, write        checks, pay bills)?    -   (Adapted from Fillenbaum G G. Screening the elderly: A brief        instrumental activities of daily living measure. J Am Geriatr        Soc. 1985; 33:698-706.)

In the following section we will discuss each of these questions andprovide rules for the automatic inference of its answer:

Can You Get to Places Outside of Walking Distance Without Help?

To infer the answer to this question automatically we can partially relyon the rule used in the inference of the answer to the second ADLquestion, regarding the subject's ability to get dressed without help,and add another condition on the distance. Hence the rule would be:

If {(Subject went out of their residence) AND (The trip made is longerthan a preset distance)} AND {[(Subject is alone at home) AND (There isNOT any indication from the motion sensors of any visitors coming intothe residence through outdoor(s) prior to the activity)] OR [(Subjecthas company) AND (Motion Sensors show continued activity in theresidence after the subject has left)]}, Then Subject has gone placesoutside of walking distance without help.

We can establish that the subject went to a place outside of walkingdistance if the subject is carries a radio frequency transmitter with apre-set range, with the receiver fixed in the subject's residence. Awireless communications device operating in extended Bluetooth modemaybe sufficient for this purpose.

Can You go Shopping for Groceries Without Help?

The inference of an answer to this question is twofold; the firstinvolves going out with out help, and while the second coming back alonewith groceries. Hence the inference rule can be formulated as follows:

If {(Subject went out of their residence) AND (Sensors' signals areindicative of putting groceries away, after their return)} AND{[(Subject is alone at home) AND (There is NOT any indication from themotion sensors of any visitors coming into the residence through entrydoor(s) prior to the activity)] OR [(Subject has company) AND (MotionSensors show continued activity in the residence after the subject hasleft)] AND (Subject returned home alone)}, Then Subject has goneshopping for groceries without help.

The sensors' signals indicative of putting groceries away after returninclude setting off kitchen cabinets, drawers and refrigerator doorswitches. Moreover, we can establish if the subject returned to theresidence alone from comparing motion sensor activities before and afterthe arrival of the subject to determine if more than one person are inthe home, after the shopping trip if the subject was alone before theshopping trip and if there is indication of additional people in thehome after the shopping trip, if the subject had company before theshopping trip.

A better confirmation of shopping for groceries will be provided if thehome was equipped with a food scanner and the subject scanned groceriesbefore storing them away; the kitchen scanner is the subject of aseparate disclosure.

Can You Prepare Your Own Meals Without Help?

The rule to infer the answer to this question is already included in thequestion related to the subject's ability to feed himself/herself formthe ADL instrument. The extracted rule is as follows:

If {(Subject is in the kitchen) AND (There are activities in thekitchen) AND [(There is an increase in the temperature over the stove,range, or oven) OR (Use of microwave oven)]}AND {[(Subject is alone athome) AND (There is NOT any indication from the motion sensors of anyvisitors coming into the residence through outdoor(s) prior to theactivity)] OR [(Subject has company) AND (Motion Sensors show continuedactivity during the activity period outside the kitchen)]}, Then Subjecthas prepared a meal and fed themselves without help.

Can You do Your Housework Without Help?

Cleaning and housework are varied; they primarily include, among otherthings, washing clothes and drying them, washing dishes, ironing andvacuuming. Thus the rule to infer the answer to this questionautomatically can be formulated as follows:

If {(The cabinet(s) containing the cleaning materials is opened) OR(There is an increase of humidity over the kitchen sink) OR (Dishwasherturned on) OR (Vacuum cleaner is turned on) OR (Washing machine isturned on) OR (Tumble dryer is turned on) OR (Iron turned on)} AND{[(Subject is alone at home) AND (There is NOT any indication from themotion sensors of any visitors coming into the residence throughoutdoor(s) prior to the activity)] OR [(Subject has company) AND (MotionSensors show continued activity during the activity period outside theroom where the activity is taking place)]}, Then Subject has donehousework without help.

The scoring of this particular rule can be made proportional to thenumber of activities performed consecutively, indicating a session ofhousework. The detection of these activities requires determiningcabinet(s) where cleaning materials are kept (such as under kitchen andbathroom sinks), and adding switches to detect activities involvingthese cabinets. Moreover, the operation of the electric appliances usedin the bulk of housework, can be achieved using wireless on/off sensorsfor portable appliances, such as the vacuum cleaner and iron, andmagnetic reed switches to detect the status of the fixed appliances(such as a washing machine or a dryer). The humidity sensor placed overthe kitchen sink would detect activity involving the use of water, suchas dishwashing.

Can You Handle Your Own Money Without Help?

We can unobtrusively establish if the subject can handle their ownmoney, indirectly from the continuation of services, such as electricitysupply, phone since this indicates payment of bills. However, it is moredifficult to confirm whether the subject is handling their finances ontheir own unobtrusively. Moreover, the question is sensitive,particularly to the elders as it may open doors for guardianship issues.Thus, we feel that it would be best to get this confirmation from thesubject by directly asking this question during the visit to the familyphysician.

Next, as best shown in FIG. 2, an embodiment of the present inventionmethod may be implemented using hardware, software or a combinationthereof and may be implemented in one or more computer systems or otherprocessing systems, such as personal digit assistants (PDAs). In anexample embodiment, the invention was implemented in software running ona general purpose computer 200 as illustrated in FIG. 2. Computer system200 includes one or more processors, such as processor 204. Processor204 is connected to a communication infrastructure 206 (e.g., acommunications bus, cross-over bar, or network). Computer system 200 mayinclude a display interface 202 that forwards graphics, text, and otherdata from the communication infrastructure 206 (or from a frame buffernot shown) for display on the display unit 230.

Computer system 200 also includes a main memory 208, preferably randomaccess memory (RAM), and may also include a secondary memory 210. Thesecondary memory 220 may include, for example, a hard disk drive 212and/or a removable storage drive 214, representing a floppy disk drive,a magnetic tape drive, an optical disk drive, a flash memory etc. Theremovable storage drive 214 reads from and/or writes to a removablestorage unit 218 in a well known manner. Removable storage unit 218,represents a floppy disk, magnetic tape, optical disk, etc. which isread by and written to by removable storage drive 214. As will beappreciated, the removable storage unit 218 includes a computer usablestorage medium having stored therein computer software and/or data.

In alternative embodiments, secondary memory 210 may include other meansfor allowing computer programs or other instructions to be loaded intocomputer system 200. Such means may include, for example, a removablestorage unit 222 and an interface 220. Examples of such removablestorage units/interfaces include a program cartridge and cartridgeinterface (such as that found in video game devices), a removable memorychip (such as a ROM, PROM, EPROM or EEPROM) and associated socket, andother removable storage units 222 and interfaces 220 which allowsoftware and data to be transferred from the removable storage unit 222to computer system 200.

Computer system 200 may also include a communications interface 224.Communications interface 224 allows software and data to be transferredbetween computer system 200 and external devices. Examples ofcommunications interface 224 may include a modem, a network interface(such as an Ethernet card), a serial or parallel communications port, aPCMCIA slot and card, a modem etc. Software and data transferred viacommunications interface 224 are in the form of signals 228, which maybe electronic, electromagnetic, optical or other signals capable ofbeing received by communications interface 224. Signals 228 are providedto communications interface 224 via a communications path (i.e.,channel) 226. A channel 226 (or any other communication means or channeldisclosed herein) carries signals 228 and may be implemented using wireor cable, fiber optics, a phone line, a cellular phone link, an RF link,an infrared link and other communications channels.

In this document, the terms “computer program medium” and “computerusable medium” are used to generally refer to media such as removablestorage drive 214, a hard disk installed in hard disk drive 212, andsignals 228. These computer program products are means for providingsoftware to computer system 200. The invention includes such computerprogram products.

Computer programs (also called computer control logic) are stored inmain memory 208 and/or secondary memory 210. Computer programs may alsobe received via communications interface 224. Such computer programs,when executed, enable computer system 200 to perform the features of thepresent invention as discussed herein. In particular, the computerprograms, when executed, enable processor 204 to perform the functionsof the present invention. Accordingly, such computer programs representcontrollers of computer system 200.

In an embodiment where the invention is implemented using software, thesoftware may be stored in a computer program product and loaded intocomputer system 200 using removable storage drive 214, hard drive 212 orcommunications interface 224. The control logic (software), whenexecuted by the processor 204, causes the processor 204 to perform thefunctions of the invention as described herein.

In another embodiment, the invention is implemented primarily inhardware using, for example, hardware components such as applicationspecific integrated circuits (ASICs). Implementation of the hardwarestate machine to perform the functions described herein will be apparentto persons skilled in the relevant art(s).

In yet another embodiment, the invention is implemented using acombination of both hardware and software.

In an example software embodiment of the invention, the methodsdescribed above may be implemented in various programs and programminglanguage known to those skilled in the art.

The various embodiments of the present invention may be implemented withthe systems and methods disclosed in the following U.S. Patents of Table1, and of which are hereby incorporated by reference herein in theirentirety: TABLE 1 U.S. Pat. No. Issue Date Title 6,524,239 Feb. 25, 2003Apparatus for non-intrusively measuring health parameters of a subjectand method of use thereof 6,108,685 Aug. 22, 2000 System for GeneratingPeriodic Reports Generating Trend Analysis and Intervention forMonitoring Daily Living Activity; 5,692,215 Nov. 25, 1997 System forGenerating Periodic Reports, Generating Trend Analysis, and Interventionin Accordance with Trend Analysis From a Detection Subsystem forMonitoring Daily Living Activity 6,282,531 Aug. 28, 2001 System formanaging applied knowledge and workflow in multiple dimensions andcontexts 6,165,143 Dec. 26, 2000 Method for measuring and indicating theextent to which an individual is limited in daily life activities6,280,409 Aug. 28, 2001 Medical for tracking patient functional status4,747,120 May 24, 1988 Automatic personnel monitoring system 4,952,928Aug. 28, 1990 Adaptable electronic monitoring and identification system5,032,823 Jul. 16, 1991 Secure personnel monitoring system 5,673,692Oct. 7, 1997 Single site, multi-variable patient monitor 4,353,375 Oct.12, 1982 Activity monitor for ambulatory subjects 5,682,882 Nov. 4, 1997Vigilance monitor system 4,286,331 Aug. 25, 1981 Monitoring andsignaling system including apparatus for processing and analyzing sig-nals produced by activity monitoring sensors 3,803,579 Apr. 9, 1974Automatic Alarm System For Bathroom 3,885,235 May 20, 1975 Resettabletimer-alarm device used in monitoring geriatric patients 5,967,975 Oct.19, 1999 Home health parameter monitoring system 5,339,821 Aug. 23, 1994Home medical system and medical apparatus for use therewith 5,576,952Nov. 19, 1996 Medical alert distribution system with selec- tivefiltering of medical information 5,785,650 Jul. 28, 1998 Medical systemfor at-home patients 4,454,502 Jun. 12, 1984 Apparatus for monitoringand signaling system 4,303,801 Dec. 1, 1981 Apparatus for monitoring andsignaling system 4,281,394 Jul. 28, 1981 Monitoring and signaling systemincluding apparatus for processing binary signals having multiplemessages 6,290,646 Sept. 18, 2001 Apparatus and method for monitoringand communicating wellness parameters of ambulatory patients 5,767,791Jun. 16, 1998 Low-Power circuit and method for providing rapid frequencylock in a wireless communications device 5,410,471 Apr. 25, 1995Networked health care and monitoring system 6,050,940 Apr. 18, 2000General-purpose medical instrumentation 6,080,106 Jun. 27, 2000 Patientinterface system with a scale 6,206,829 Mar. 27, 2001 Computerizedmedical diagnostic and treat- ment advice system including networkaccess 6,402,691 Jun. 11, 2002 In-home patent monitoring system3,572,316 Mar. 23, 1971 Physiological signal monitoring system 4,838,275Jun. 13, 1989 Home medical surveillance system 5,462,051 Oct. 31, 1995Medical communication system 5,905,436 May 18, 1999 Situation BasedMonitoring System 6,171,237 Jan. 9, 2001 Remote health monitoring system6,220,101 Apr. 24, 2001 Apparatus for Measuring Multiple Pressures6,348,867 Feb. 19, 2002 Control System for building automation controlby human physiological signals 6,433,690 Aug. 13, 2002 Elderly FallMonitoring Method and Device 6,445,298 Sept. 3, 2002 System and Methodfor remotely monitoring movement of individuals 4,259,548 Mar. 31, 1981Apparatus for monitoring and signaling system

The various embodiments of the present invention may be implemented withthe systems and methods disclosed in the following PCT InternationalApplications, and of which are commonly owned by the present assigneeand are hereby incorporated by reference herein in their entirety:International Patent Application No. PCT/US04/09098, entitled “Methodand System for the Derivation of Human Gait Characteristics andDetecting Fall Passively from Floor Vibrations,” filed Mar. 26, 2004 andInternational Patent Application No. PCT/US04/09099, entitled “Systemand Method for Passive Monitoring of Blood Pressure and Pulse Rate,”filed Mar. 26, 2004.

PUBLICATIONS

The following references are hereby incorporated by reference herein intheir entirety:

-   1—Fillenbaum G G. Screening the elderly: A brief instrumental    activities of daily living measure. J Am Geriatr Soc. 33:698-706    (1985).-   2—Fleming K C, Evans J M, Weber D C, Chutka D S. Practical    Functional Assessment of Elderly Persons: A Primary-Care    Approach.Mayo Clin Proc. 70:890-910 (1995).-   3—Fried L P, Guralnik J M. Disability in Older Adults: Evidence    regarding significance, etiology, and risk. J Amer Geriatr Soc.    45:92-100 (1997).-   4—Kane R, Assessing the Elderly in A. Monk (Ed.), Handbook of    Gerontological Services. New York, Van Nostrand Reinold Company,    (1985).-   5—Katz S, Ford A B, Moskowitz R W, Jackson B A, Jaffe M W, Cleveland    M A. The index of ADL: A standardized measure of biological and    psychosocial function. JAMA. 185:914-919 (1963).-   6—Reuben D B. What's wrong with ADLs? J Am Geriatr Soc. 43:936-7    (1995).

It should be understood that while the method described was presentedwith a certain ordering of the steps, it is not our intent to in any waylimit the present invention to a specific step order. It should beappreciated that the various steps can be performed in different orders,for example, the type and number of survey questions may altered.Further, we have described herein the novel features of the presentinvention, and it should be understood that we have not included detailswell known by those of skill in the art, such as the design of varioustypes of sensor devices.

Still other embodiments will become readily apparent to those skilled inthis art from reading the above-recited detailed description anddrawings of certain exemplary embodiments. It should be understood thatnumerous variations, modifications, and additional embodiments arepossible, and accordingly, all such variations, modifications, andembodiments are to be regarded as being within the spirit and scope ofthe appended claims. For example, regardless of the content of anyportion (e.g., title, section, abstract, drawing figure, etc.) of thisapplication, unless clearly specified to the contrary, there is norequirement for any particular described or illustrated activity orelement, any particular sequence of such activities, any particularsize, speed, dimension or frequency, or any particular interrelationshipof such elements. Moreover, any activity can be repeated, any activitycan be performed by multiple entities, and/or any element can beduplicated. Further, any activity or element can be excluded, thesequence of activities can vary, and/or the interrelationship ofelements can vary. Accordingly, the descriptions and drawings are to beregarded as illustrative in nature, and not as restrictive.

1. A method to automatically derive answers to the questions of twoclinical functional assessment instruments activities of daily living(ADLs), and all but one of the instrumental activities of daily living(IADLs) relying on sensors targeting the side-effects of the activities,said method comprising: date and time stamping sensor firings; andsetting a set of rules method where the spatio-temporal relationships ofsensor firings are examined and analyzed to infer the occurrence ofactivities of interest, wherein said rules include at least one of thefollowing: a rule to automatically bathing/showering, a rule toautomatically detect dressing, a rule to automatically detect toiletingevents, a rule to automatically detect the ability to ambulate (get outof bed/chair), a rule to automatically detect problems in controllingbladder and/or bowels, a rule to automatically detect the ability tofeed oneself, a rule to automatically detect the ability to get toplaces outside of walking distance, a rule to automatically detect theability to shop for groceries, a rule to automatically detect theability to prepare meals, and a rule to automatically detect the abilityto do house work.
 2. A system to automatically derive answers to thequestions of two clinical functional assessment instruments activitiesof daily living (ADLs), and all but one of the instrumental activitiesof daily living (IADLs), said system comprising: a sensor module,wherein said sensor module targets the side-effects of the activities;and a processor module, said processor module programmed to: a) date andtime stamp sensor firings; and b) set a set of rules where thespatio-temporal relationships of sensor firings are examined andanalyzed to infer the occurrence of activities of interest, wherein saidrules include at least one of the following: a rule to automaticallybathing/showering, a rule to automatically detect dressing, a rule toautomatically detect toileting events, a rule to automatically detectthe ability to ambulate (get out of bed/chair), a rule to automaticallydetect problems in controlling bladder and/or bowels, a rule toautomatically detect the ability to feed oneself, a rule toautomatically detect the ability to get to places outside of walkingdistance, a rule to automatically detect the ability to shop forgroceries, a rule to automatically detect the ability to prepare meals,and a rule to automatically detect the ability to do house work.
 3. Acomputer program product comprising computer useable medium havingcomputer program logic for enabling at least one processor in a computersystem to automatically derive answers to the questions of two clinicalfunctional assessment instruments activities of daily living (ADLs), andall but one of the instrumental activities of daily living (IADLs)relying on sensors targeting the side-effects of the activities, saidcomputer logic comprising: date and time stamping sensor firings; andsetting a set of rules method where the spatio-temporal relationships ofsensor firings are examined and analyzed to infer the occurrence ofactivities of interest, wherein said rules include at least one of thefollowing: a rule to automatically bathing/showering, a rule toautomatically detect dressing, a rule to automatically detect toiletingevents, a rule to automatically detect the ability to ambulate (get outof bed/chair), a rule to automatically detect problems in controllingbladder and/or bowels, a rule to automatically detect the ability tofeed oneself, a rule to automatically detect the ability to get toplaces outside of walking distance, a rule to automatically detect theability to shop for groceries, a rule to automatically detect theability to prepare meals, and a rule to automatically detect the abilityto do house work.